The Province, February 8, 2013.

How many children have to hurt themselves or take their own lives
before there is action? How many people have to be critically injured or
murdered by individuals who are acutely mentally ill and in urgent need
of psychiatric care before the B.C. government takes responsibility for
the fact that the child, youth and adult civil mental-health systems
are failing an increasing number of people?

The names in the media articles change, but the stories remain the
same: mentally ill people, some of whom are openly aggressive and
violent toward others, often family members, or those who express
suicidal and homicidal ideation to mental-health professionals,
deteriorate to the point where they hurt themselves, harm or kill
others. These incidents are not random and we must connect the dots to
see why this is happening in B.C.

When family members see tragedy bearing down like a runaway freight
train, why do they have to struggle alone and powerless to get their
loved ones help from the only systems set up to provide it — the
community mental-health system and the acute-care psychiatric services
in hospitals?

Having worked as a psychiatric social worker in the youth and adult
forensic psychiatric and civil mental systems I am unequivocal in
stating that mental-health assessment and treatment has never been more
difficult to access for children, youth and adults. The system of care
from community mental health to acute psychiatric-care units, to
long-term tertiary care, to supportive community housing is vastly
underfunded and understaffed.

Many professionals working in this area of practice also do not have
adequate training and ongoing professional development to ensure they
are working together to provide the most competent, ethical and
evidence-based care possible.

If someone has a broken arm, an acute heart condition or any other
serious physical condition we would not dream of denying them access to
health care. This is radically different for mental-health injury and
illness for people of all ages. Mental illness continues to be
stigmatized, just like those who suffer from mental health issues, who
face extraordinary discrimination in daily life.

The B.C. government, in their 2010 report, Healthy Minds, Healthy
People, stated that “over any 12-month period, about one in five
individuals in the province will experience significant mental-health
and/or substance-use problems leading to personal suffering and
interference with life goals.” So they have at least recognized the
immensity of the problems that occur for individuals, often starting in
childhood.

The report goes on to state that a “recent Canadian study has
suggested that mental illness costs the Canadian economy $51 billion
annually in lost productivity — B.C.’s proportional share of this burden
would be more than $6.6 billion each year.” In spite of creating these
lofty reports, which lack concrete plans, something is going horribly
wrong in the process of designing, implementing and carrying out
services around B.C.

Thankfully, the office of the Representative for Children and Youth
is studying the child and youth mental-health system, but the entirety
of B.C.’s mental-health system of care from cradle to grave must be put
under the microscope. Mental-health services are fragmented and
regionalized across six different health authorities and the Ministry of
Children & Family Development for children and youth.

All of these organizations have created their own bureaucratic
infrastructures and administrative cultures, which has led to a serious
lack of oversight, monitoring and accountability and no cohesion,
sometimes even within the same organizations.

The B.C. government must take strong, decisive leadership to create a
comprehensive, accountable plan that includes measurable goals for
mental-health services across the province to ensure timely access to
care and best practices in assessment and treatment are occurring within
the system, within all program areas and organizations providing
services.

Efforts must also be made to change the structure and culture of
practice within the mental-health system of care. As many families find
there are complex barriers to accessing both community and acute
psychiatric hospital care for children, youth and adults. If individuals
make it into acute-care units, structural and administrative priorities
of moving people out of acute-care beds as fast as possible have
replaced client-centred care, treatment and effective discharge planning
to ensure that gains made in hospital are maintained as people transition back into the community.

There must also be increased training for clinicians working in the
system in assessing risk of self-harm and violence toward others as it
has become all too clear that the civil mental-health system is often
failing to adequately assess these risks.

In media story after story we learn that individuals were given
cursory assessment and “treatment” in the civil system and then went on
to commit violent crimes, often later being found Not Criminally
Responsible on account of Mental Disorder.

A provincewide acute psychiatric care system that prioritizes getting
people out of beds over a slower, measured process of assessment and
treatment is leading to a normalization and minimization of risk factors
that put individuals at risk.

Albert Einstein said the definition of insanity is doing the same
thing over and over again and expecting different results. I am
labelling the current B.C. government as the ones who are insane for
sitting on their hands, year after and year, ignoring the tragic
failures, impacts and loss of dignity and human life that is resulting
from the failures of the mental-health system of care that they have
created.

With the provincial election occurring on May 14, it is time for all
political parties to get real, get concrete and to stop twiddling their
thumbs and inform voters what their strategic plans are to improve the
mental-health system of care for children, youth and adults.

Individuals with mental illness, family members, professionals
working in the field and concerned citizens have surely run out of
patience waiting for the B.C. government to improve accessibility to the
entire range of mental health services needed, improving outcomes and
enabling people to live with the dignity and rights that everyone else
takes for granted.